13Legal and Ethical Issues in Medical Practice, Including HIPAA 2Learning Outcomes3.1 Define ethics, bioethics, and medical law. 3.2 Discuss the measures a medical practice must take to avoid malpractice claims. 3.3 Discuss medical documentation and how it applies to medical law. 3Learning Outcomes (cont.)3.4 Discuss the various types of health-care legislation. 3.5 Describe OSHA requirements for a medical office. 3.6 Describe procedures for handling an incident of exposure to hazardous materials. 4Learning Outcomes (cont.)3.7 Compare and contrast quality control and quality assurance procedures. 3.8 Discuss the impact that HIPAA regulations have in the medical office. 3.9 Explain how to protect patient confidentiality. 3.10 Describe the different practice management models. 5Introduction

Reasons to study medical law and ethics

Function at the highest professional level

Avoid legal problems

6Medical Law and Ethics

Knowledge of medical law and ethics provides insight into

The rights, responsibilities, and concerns of health-care consumers

The legal and ethical issues facing society, patients, and health-care professionals as the world changes

The impact of rising costs on the laws and ethics of health-care delivery

7Medical Law and Ethics (cont.)LawEthicsEthics is a standard of behavior and a concept of right or wrong. Moral values serve as the basis for ethical conduct. Family, culture, and society help form an individuals moral values. A law is a rule of conductor action prescribed or formally recognized as binding or enforced by a controlling authority. 8Medical Law and Ethics (cont.)

Criminal law

Crime against the state

Criminal acts are

Felonies or

Misdemeanors

Examples include

Murder

Arson

Sexual assault

Burglary

Civil law

Crimes against the person

Includes a general category of laws known as torts

Torts are either

Intentional (willful) or

Unintentional (accidental)

9Intentional TortsOpen threat of bodily harmAn action that causes bodily harm to another, including touching without permissionAssaultBatteryInvasion of privacy Depriving or attempting to deprive a person of his or her rightsFraudInterference with a persons right to be left aloneFalse imprisonmentDefamation of character Damaging a persons reputation by making false and malicious public statementsIntentional, unlawful restraint or confinement of a person 10Unintentional Torts

Acts that are committed with no intent to cause harm but done with a disregard for the consequences

The term negligence is used to describe such actions when health-care practitioners fail to exercise ordinary care, resulting in patient injury

Malpractice is the negligent delivery of professional services

11ContractsA contract is a voluntary agreement between two parties in which specific promises are made for a consideration. Elements of a Contract 12Types of Contracts

Expressed contracts

Clearly stated in written or spoken words

An example is a payment contract

Implied contracts

Actions or conduct of the parties, rather than words, create the contract

An example is a patient rolling up his or her sleeve to receive an injection

13Apply Your KnowledgeWhat is the difference between law and ethics?ANSWER A law is a rule of conduct or action and is enacted by governments to maintain order and public safety. Ethics is a standard of behavior based on moral values that are influenced by family, culture, and society.Good Answer! 14Physician/Patient Contract

Reasonable limitations

Both parties have rights and responsibilities related to the contract

15Physician Rights

Set up a practice within the boundaries of his or her license to practice medicine

Select where to set up an office and establish office hours

Specialize

Decide which services to provide and how those services will be provided

Physicians do not have to

Treat every patient

Return patient to original state of health

Make a correct diagnosis in every case

Guarantee success of treatment or operation

16Physician Responsibilities

Physician responsibilities

Use due care, skill, judgment, and diligence

Keep knowledge up-to-date

Perform to the best of his or her ability

Furnish complete information and instructions to the patient

17Patient Rights/Responsibilities

Patient responsibilities

Follow physicians instructions and cooperate with care

Provide relevant information to the physician

Follow the physicians orders for treatment

Pay the fees charged for services provided

Patients

May choose their physician

May terminate a physicians services

The Patient Care Partnership

A list of standards that patients can expect in health care

Formerly the Patients Bill of Rights

18Patient-Physician Contract (cont.)

Consent

Implied actions imply permission

Informed

Patient receives all information necessary to make a decision regarding treatment

Doctrine of informed consent legal basis for informed consent

Liability

Legal responsibility for actions

Understand scope of practice

Understand standard of care and duty of care

Medical assistants are all held to the reasonable person standard

19Special Circumstances Closing of a Practice

Comply with HIPAA

Notify patients in writing

Give option of choosing another physician or make referral

Secure or dispose of records appropriately

Remain up-to-date on HIPAA laws

20Apply Your KnowledgePatients have rights and responsibilities relating to health care. The rights are determined by the Patient Care Partnership. What are the patients responsibilities?

ANSWER Patient responsibilities are

Follow physicians instructions and cooperate with plan of care

Provide relevant information to the physician

Follow the physicians orders for treatment

Pay the fees charged for services provided

Good Job! 21Preventing Lawsuits

Lawsuits

Add to cost of health care

Take a psychological toll on all involved

Prevention

Use of reasonable care to prevent professional liability

22Malpractice

Malpractice claims are lawsuits by a patient against a physician for errors in diagnosis or treatment

Negligence cases are those in which a person believes a medical professionals actions, or lack thereof, caused harm to the patient

Examples abandonment, delayed treatment

23Malpractice (cont.)

Legal terms used to classify negligence

Malfeasance - unlawful act or misconduct

Misfeasance - lawful act done incorrectly

Nonfeasance - failure to perform an act that is ones required duty or that is required by law

24The 4 Ds of NegligenceDPatients must be able to prove all 4 Ds in order to move forward with a malpractice suit. 25Malpractice (cont.)

Settling malpractice suits

Arbitration

People with special knowledge in the field listen to the case and decide the dispute

Court

Written court orders (subpoena) are delivered to involved parties.

Subpoena duces tecum is a court order to produce documents such as patient records

Civil law

Concerned with an individuals private rights

Torts

Negligence

Breach of contract

Failure to adhere to a contracts terms

26Malpractice (cont.)

Law of Agency

Employees are considered to be agents of the physician while performing professional tasks

Physicians are responsible or liable for the negligence of employees

Respondeat superior is a Latin term meaning Let the master answer

Employees are also legally responsible for their own actions, and they can be sued directly. 27Courtroom Conduct

Attend court proceedings as required and do not be late for scheduled hearings

Bring required documents to court and present them when requested to

Refresh your memory before testifying

Speak slowly, clearly, and professionally

Answer all questions in a straightforward manner

Answer only the question asked

Appear well groomed, and dress in clean, conservative clothing

28Malpractice (cont.)

Reasons patients sue

Unrealistic expectations

Poor rapport and poor communication

Greed and our litigious society

Poor quality of care

Professional Liability Coverage protects the physician and staff against financial losses from lawsuits filed against them

29Malpractice (cont.)

Statute of limitations

Laws that set the deadline or maximum period of time within which a lawsuit or claim may be filed

Deadlines vary

Type of case

State vs. federal court

30The 4 Cs of Malpractice PreventionC 31Terminating Care of a Patient

Reasons for terminating care of a patient

Refusal to follow physician instructions

Patient family member complaints

Personality conflicts

Failure to pay for services rendered

Repeated failure to keep appointments

When withdrawing from care, a physician must

Provide written notification

Reasons for withdrawing

Recommend that the patient find another physician

Send by certified mail with return receipt requested

Document in the patient record reasons for terminating care and actions taken to inform the patient

32Standard of Care

Apply legal concepts to practice by

Maintaining confidentiality

Practicing within the scope of training and capabilities

Preparing and maintaining medical records

Documenting accurately

Using proper guidelines when releasing information

33Standard of Care (cont.)

Apply legal concepts to practice by

Following legal guidelines and maintaining awareness of health-care legislation and regulations

Maintaining and disposing of regulated substances appropriately

Following risk-management and safety procedures

Recognizing professional credentialing criteria

34Administrative Duties and the Law

Duties related to legal requirements

Insurance billing

Patient consent forms

Documentation in the medical record

Making appointments

Appointment books are a legal document

State reporting requirements

Births

Abuse

Certain diseases

Injuries from violent acts

Deaths

Phone calls

Maintain privacy

35Documentation

Clear and complete

Referrals

Missed appointments

Dismissals

Patient contact

Medical record correction

Medical records

Property of facility or physician

Doctrine of Professional Discretion

Retention and storage

Based on state law

36Controlled Substances and the Law Be familiar with correct dosages, potential complications, and refill rules.Medical assistants must follow the correct procedure for keeping and disposing of controlled substances. 37Legal Documents and the PatientStates the types of treatment the patient does and does not want in an event of terminal illness, unconsciousness, or comatose state. Patients with living wills are asked to name someone that will make decisions on their behalf (durable power of attorney) if they are unable to do so.Living Will (Advance Directive)Uniform Donor Card A legal document that states a persons wish to donate one or more organs or whole body. 38Confidentiality Issues

Establish appropriate safeguards to protect the privacy of health information

Hold violators accountable if they violate patients privacy rights

Strike a balance when public responsibility supports disclosure of some forms of data

48HIPAA (cont.)

Privacy Rule protected health information (PHI)

Use movement within an organization

Disclosure transmitted between or among organizations

Managing and storing

Sharing

Notice of Privacy Practices (NPP)

Protection security measures

HIPAA Security Rule

Computer networks

The Internet

Disks, other storage media, and extranets

Chart

Reception area and clinical stations

Fax, copier, and printer

49HIPAA (cont.)

Violations and penalties

Civil

Criminal for the knowing, wrongful misuse of health information

Administrative simplification

Standardizing patient information

Standardized codes and formats electronic transaction records

50Apply Your KnowledgeWhile you are documenting on the computer, you are called to a patient room for an emergency. What should you do before leaving the computer?ANSWER You should close the patient record and log off the computer to protect the confidentiality of patient information.Good Answer! 51Confidentiality Issues and MandatoryDisclosure

Principles for preventing improper release of information

When in doubt, do not release information

It is the patients right to keep patient information confidential or disclose it

All patients should be treated with the same degree of confidentiality

Be aware of all applicable laws and of the regulations

52Confidentiality Issues and MandatoryDisclosure (cont.)

Principles for preventing improper release of information

When necessary to break confidentiality and when there is a conflict between ethics and confidentiality

Discuss it with the patient

If the law does not dictate what to do in the situation, the attending physician should make the judgment based on the urgency of the situation and any danger that might be posed to the patient or others

Get written approval from the patient before releasing information

53Apply Your KnowledgeA police officer enters the physicians office where you work and requests information about a patient. May you release this information? What should you do?ANSWER No, you should not be the person to release this information. You should refer the officer to the patients physician, who will make the judgment based on the urgency of the situation and any danger that might be posed to the patient or others.YES! 54Code of Ethics

Principles of right and wrong

Laws are often based on ethical considerations

Medical professionals are expected to act ethically

55Code of Ethics (cont.)

Bioethics

Pertains to issues that arise due to medical advances

Principles of medical ethics have developed over time dating back to Hippocrates

An agreement between two or more competent people to do something legal

Names and addresses of the people involved

Consideration (whatever is given in exchange, such as money, work, or property)

Starting and ending dates, as well as date(s) the contract was signed

Signature of the employer and employee

57Apply Your Knowledge Mr. Jones would like to try a new treatment for his Parkinsonism, but his physician refuses to discuss a new treatment with Mr. Jones because he morally disagrees with this type of treatment. This is an example of what type of issue, and what should the physician do?ANSWER This is an example of a bioethical issue. The physician should refer the patient to another physician who specializes in this treatment.Good Answer! 58Labor and Employment Laws

Title VII of the Civil Rights Act of 1964

Law prevents employers from discriminating in hiring or firing on the basis of race, color, religion, sex, or national origin

Age Discrimination in Employment Act (ADEA) of 1967

Prohibits discrimination in hiring or firing based on age for persons aged 40 or older

Sexual harassment

The victim has the responsibility to let the harasser know that the conduct is offensive

The victim should also report any instance of sexual harassment to a supervisor or the personnel department

59Labor and Employment Laws (cont.)

1976 Pregnancy Discrimination Act

Makes it illegal to fire an employee based on pregnancy, childbirth, or related medical conditions

Require all commercial firms to make existing facilities and grounds more accessible to the disabled

61Labor and Employment Laws (cont.)

1938 Fair Labor Standards Act

Prohibits child labor and firing employees for exercising their rights under the acts wage and hour standards

Provides for overtime pay and a minimum wage

Equal Pay Act of 1963

Requires equal pay for men and women doing equal work

Family Leave Act of 1991

Allows employees to take unpaid leave time for maternity, for adoption, or for caring for ill family members

62Apply Your Knowledge What are your responsibilities if you feel you have been a victim of sexual harassment?ANSWER The victim has the responsibility to let the harasser know that the conduct is offensive and should also report any instance of sexual harassment to a supervisor or the personnel department.Good Job! 63Legal Medical Practice Models

Be aware of laws governing the practice model of your place of employment

Five types of practice models

Sole proprietorship

Single physician

Partnership

Two or more physicians practice together

Contract specifies rights, obligations, and responsibilities

64Legal Medical Practice Models (cont.)

Professional corporation

Corporation is a body formed and authorized by law to act as a single entity

Physicians who form corporations are shareholders and employees of the organization

Incorporators and owners have limited liability in case lawsuits are filed

66Apply Your KnowledgeWhat is the difference between a group practice and a professional corporation?ANSWER A group practice is three or more physicians who share the practice income, expenses, and facilities. In a professional corporation the physicians are shareholders and employees of the corporation.Right! 67In Summary

3.1 Ethics deals with general principles of right and wrong. Allied health professionals are expected to do the right thing in all aspects. Bioethics arise from issues that deal with medical advances.

3.2 The four Cs of malpractice prevention are caring, communicating, competency, and charting properly.

3.3 Medical documentation is essential.

68In Summary (cont.)

3.4 Federal legislation affects health care.

3.5 OSHA regulations state that the medical assistant must

Have protective gear

Know how to properly decontaminate

Know how to dispose properly of sharp equipment

Notify officials of exposure incidents

Have a post-exposure evaluation and follow-up procedures

Know how to handle potentially infectious laundry

Be informed about hazardous materials

69In Summary (cont.)

3.6 When an exposure incident occurs, the medical assistant must immediately notify the physician/employer or supervisor.

3.7 Quality controls have regulated set standards that seek quality in the work performed and accuracy of test results after the work is performed.

3.8 HIPAA (Health Insurance Portability and Accountability Act) regulations have a great impact in the medical office today because they address issues such as health-care fraud and abuse, medical liability reform, and standardizing patient information throughout the health-care system.

70End of Chapter 3Let no one come to you without leaving better and happier. Mother Theresa

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